2015-01-22 PA WGM Minutes

Patient Administration Work Group Meeting – Thursday January 22, 2015

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Thursday Q1

HL7 Patient Administration Meeting Minutes Location: Directors Conference Room		Date: 2015-01-22 Time: Thursday Q1
Facilitator	Line Saele	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	HL7 Norway
X	Alexander Henket	HL7 Netherlands
X	Rob Savage	NGC/CDC, USA
X	Mike Martin	AAVLD, USA
X	Toril Reite	HL7 Norway
X	John Roberts	Tennessee Department of Health, USA
X	Josh Roberson	EPIC, USA
X	Alex de Leon	Kaiser Permanente
X	Craig Newman	EPIC, USA
X	Iryna Roy	Gevity, Canada
X	Joginder Madra	Madra Consulting, USA
X	Amit Popat	EPIC, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

• Harmonization of CMETs joint with PHER

Supporting Documents

• Harmonization PRPA DMIM with PHER DMIM

Minutes

Introductions
Harmonization of CMETs joint with PHER
Alexander Henket reviewed the DMIMs (PRPA DMIM and PHER DMIM) that span both WG domains with the PA and PHER.
PRPA DMIM
The documentation for comparison has been stored in gforge at:
"Project 1100 - Harmonization PRPA DMIM with PHER DMIM.docx" in GForge / Patient Administration / Docs / Projects
In summary, Alexander felt that the PHER model the PA models have structural differences as well as missing elements and may not be worth the effort to harmonize the models. In discussion, some “low hanging fruit” that could be harmonized. Mainly, this has to do with missing elements. The more difficult areas have to do with rearranging the DMIM and adding classes for harmonization. We could at least identify the easier things to harmonized versus the harder things. The WGs discussed the need for the harmonization and decided that the need for this grew out of an internal interest to harmonize. In other words, there are no external pushes to harmonize the models.
Our modeling facilitator (Alexander H) asked the WG what the next steps. Alex d suggested that we at least further the project (which was about assessing the models) by identifying what the easy items to fix are versus what the harder things are. This way we will better be able to make a decision of what should be exectuted. If there is a further execution of harmonization, this will require another project scope statement.
Line asked if PHER has looked at the Patient PHIR resource to assure it meets the needs, looking to the future. So far, PHER has only looked at immunization for developing resources and the current Patient resource seems to meet the needs so far. Alex d commented that this further assessment of differences between the DMIMs might “tease out” some elements that are needed by the Patient resource, or might even mean the creation of a new resource (e.g. “Subject”).
There were some clarifying questions about the models that Alexander posed at this time.
Having decided on these actions, the WG moved on to the next shared subject.
OASIS and the two efforts.

• Bridging of the TEP to HL7 standards
• HAVE

The PHER representatives stated that the MOU has been completed in the last day or so.

• Action: Speak to Karen about the MOU so that we can complete the PSS for the OASIS HAVE and TEP.
  

Having discussed this, Line suggested that we move to try to find the “low hanging fruit” based on the spreadsheet that Alexander H sent.
Place of death and place of birth were considered and need more clarification of use and reason for inclusion on the PHER model before deciding to add to the PA model.
Alexander only asks that if we add an element to the PA model, that a use case to support be provided. PHER will provide these after for conferring with Austin Kreisler. The method to do this will be the spreadsheet which will be updated back to GForge.

Meeting Outcomes

Actions (Include Owner, Action Item, and due date) Action Item:

Next Meeting/Preliminary Agenda Items .

Thursday Q2

HL7 Patient Administration Meeting Minutes Location: Directors Conference Room		Date: 2015-01-22 Time: Thursday Q2
Facilitator	Line Saele	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	HL7 Norway
X	Alex de Leon	Kaiser Permanente, USA
X	Daniel Lowenstein	EPIC, USA
X	Josh Roberson	EPIC, USA
X	Alexander Henket	Nictiz, The Netherlands
X	Toril Reite	HL7 Norway
X	Beat Heggli	HL7 Switzerland
X	Brian Postlethwait	Health Connex, Australia
X	Iryna Roy	Gevity, Canada
X	Mary Kay McDaniel	Cognosante, USA
X	Peter Bernhardt	Relay Health, USA
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

Supporting Documents

Minutes

Introductions
Joint with Financial Management
FHIR considerations.
Paul Knapp, representing Financial Management displayed the financial resources as they currently stand.

• EligibilityRequest
• EligibilityResponse
• Claim
• ClaimResponse
• Reversal
• Readjudication
• StatusRequest
• StatusResponse
• PendedRequest
• PaymentNotice
• PendedRequest
• PaymentReconciliation
• SupportingDocumentation
• ExplanationOfBenefit

Line directed the conversation back to the material that might be relevant to both WGs. This seems to be around consent and coverage.
After much discussion about the resources currently being worked on by Financial Management, it became clear that the Billable resource. This is where the shared work might lie.
The question was asked about how the entity responsible for the payment of the service rendered.
This seems to be in the Coverage resource. After discussion and review, it seemed that this did not meet this need.
So, there seems to be a resource missing that would allow the creating of a billing record.
After agreement of the need of this “Billing Record” resource by both WGs, the question of who would create the resource proposal was discussed. It was decided that PA would own the creation of the resource proposal.

• Action: Create resource proposal for this new resource., Responsible: Brian, Due: 2/6/2015
  

Will draft the resource proposal and maybe the resource itself.
Guarantor is yet to be created as it would be part of Account, which is yet to be created.
ConsentDirective is a profile of Contract. The consent need for PA is the consent to share information (e.g. about the patient). In talking about the Subject, Actor and Patient record we want to see… who the organization that owns it and who is the organization releasing information to and then details about what can be released. This should be discussed with CBCC for the process flow intended with the Consent.

• Action: Alex d to model account to encompass Guarantor to help with the v2 mapping.
  

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)

Next Meeting/Preliminary Agenda Items .

Thursday Q3

HL7 Patient Administration Meeting Minutes Location: Directors Conference Room		Date: 2015-01-22 Time: Thursday Q3
Facilitator	Line Saele	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	HL7 Norway
X	Alex de Leon	Kaiser Permanente, USA
X	Alexander Henket	HL7 The Netherlands
X	Iryna Roy	Gevity, Canada
X	Marten Smits	Furore, The Netherlands
X	Brian Postlethwaite	Health Connex, Australia
X	Josh Roberson	EPIC, USA
X	Peter Bernhardt	Relay Health, USA
X	Daniel Lowenstein	EPIC, USA
X	Christian Hay	GS1, Switzerland
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

Supporting Documents

• Reconciliation post January 2014 of Identity Document

Minutes

Introductions
Iryna motioned that because we have completed all FM business in Q2 (which was originally scheduled to be continue in this session) that we should change the Q3 agenda to continue ballot reconciliation.
Motion was seconded by Brian.
Vote: 8/0/0 in favor of changing agenda.

FHIR DSTU Ballot Reconciliation (cont.)

Item 5192: HealthCareService ServiceProvisionCode

Previous notes reviewed.
Discussion concluded that the "free" part is missleading, and should be removed.
Prop Name: ServiceProvisionCode
Cardinality from 0..1 to 0..*
Description: The code(s) that detail the conditions under which the healthcare service is available/offered.

The provision means being commissioned by, contractually obliged, financially sourced.
types of costings that may apply to this healthcare service, such if the service may be available for free, some discounts available, or fees apply.
Discussion needs to continue...

• Action item for Brian to follow up with Prashant to do additional work on the description of the ServiceProvisionCode.
  

- Item 5185: Person resource
This item was discussed in today's Q1 Modelling and Methodology meeting. Referred back to PA for further discussion.
Daniel: "See also" on Patient affords linking Patient to other Patient resources. Daniel expressed concerns that using Person to solve same problem may add additional complexity.

Brian: linking in the Patient resource is related primarily to internal merge familiar in v2 ADT merge events.
But all Person registries have an additional concept around relating Patients externally. Additionally, Person exists outside health context.

Daniel: Link on Patient is almost same strength as Person.

Josh: Modelling complexity is removed in the case of current Person resource. Still allows for multiple systems to associate patient records directly.

Brian: Relating patient and practitioner externally is not a practical use case. More likely that RelatedPerson will get abused.

Alex: At Kaiser, an initiating record is a "member". From this member a patient is created with the original member data. Use case here is member is purely a container of person demographics that are source data for creating role based entities (e.g., patient).

Daniel: returning to cross-domain linking scenario, why can't "see also" work? Current definition of this enumeration value follows:

"The patient resource containing this link is in use and valid, but points to another patient resource that is known to contain data about the same person. Data in this resource might overlap or contradict information found in the other patient resource. This link does not indicate any relative importance of the resources concerned, and both should be regarded as equally valid."

Brian: this does not allow for any level of confidence in association.

Daniel: Service locator service scenario - only a portion of participating members may support person, the hub record would need to link to all associated servers across disparate types. How would they know which to query? Patient or Person?

Peter: they would query based on a known identifier for a patient.

Brian has two use cases from Australia for person-based linking: 1) around relating patient to related person, and 2) for creating record from existing person.

Daniel: Is there is a way for a client to query for one thing (and not know that it needs to search for both)? User interfaces and work flow would necessarily have to make Person/Patient/RelatedPerson/Practitioner differences invisible to users.

Peter: CommonWell does make person/patient transparent to users. Workflows are designed to interact primarily with Patient resources. Only workflow involving Person is when system either match a local Patient record to a Person or, not finding one in a search, create a new Person and then create the link. The different resources used are not surfaced directly in the user interface.

Daniel: do we have language that clarifies when a Person may exist without a Patient?

The Work Group reviewed current description for Person and further discussion indicates we need to better describe the use case of Person outside of a linking scenario (e.g., the Kaiser member creation use case).

Alex asked if submitter concerns were satisfied.

Daniel: suggested that do not include "see also" and added as an extension.

Josh: why are they not complimentary? The use case is x-organization linking of patient records).

Daniel: In CareEverywhere, it is more of a patient-to-patient style link (also uses IHE PDQ and XCPD).

Brian proposed adding explanation text to clarify patient-specific linking versus person-linking, and expectations of client and servers in querying persons and patient. For example, search scenarios for looking at both person and patient (need use cases for clarifying this).

Brian raised motion to include new text in person resource that clearly differentiates linking between patient and person and the usage/guidance of the two resources to alleviate some ambiguity.
Seconded by Daniel.
Any more discussion? None requested.
Vote: 6/0/1 (Iryna left room before vote)

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)

Next Meeting/Preliminary Agenda Items .

Thursday Q4

HL7 Patient Administration Meeting Minutes Location: Directors Conference Room		Date: 2015-01-22 Time: Thursday Q4
Facilitator	Line Saele	Scribe	Alex de Leon
Attendee	Name	Affiliation
X	Line Saele	HL7 Norway
X	Toril Reite	HL7 Norway
X	Alex de Leon	Kaiser Permanente, USA
X	Alexander Henket	HL7 Netherlands
X	“Update attendees”
X		Canada
Quorum Requirements Met (Chair + 2 members): Yes

Agenda

Agenda Topics

• Wrap up

Supporting Documents

Minutes

Introductions
Agenda Change
Alexander moves to address

• Approve next ballot
  
• FHIR Planning
  

In the next telecom. Christian seconds.
Discussion: None
Vote: 5/0/0
Motion passes.
Administration/Wrap Up
Alex stated that he spoke to David Hamill and that the next milestone dates are what are used for metrics. He also let us know that the update to the statuses for the projects.
The WG noted that there were two projects for FHIR (DSTU1 and DSTU2). Project#s

• Action: Update the milestones for projects in Project Insight. Responsible: Alex Due: March 2015
  

Line asked Alexander about the ballot for harmonization. Alexander reminded the WG that any actions on this would require a PSS. February deadline for PSS is too aggressive for execute any of the assessment iteams. Hence we should do this when we can and potentially submit it in September. So we have ballotable content in the DMIM based on the work done.
Line stated that the PSS for the analysis PSS # 1100 has not been approved by the steering division although Alexander stated that the work has already been done. Line and Alex will follow up on this.

• Action: Follow up on the approval of PSS # 1100 with the steering division. Responsible: Alex and Line, Due: March 2015
  

We looked at the projects for PA as shown on the project database at HL7.org. We realized that this has not been put on the 3 year work plan. This was added under the heading of Harmonization.
Alexander checked that it’s in the January 2015 Ballot materials. We will need to follow up with Lynn about the publication status of the PSS# 978.

• Action: Follow up with Lynn about the status of these items. Responsible: Alex, Due: March
  

Project #s 1029, 987, 576 also have request for publication status. They should be update in project insight as done.

• Action: Follow up with Lynn on these. Reponsible: Alex, Due: March
  

Project# 1099 Chapter 3 Chapter 8 Chapter 10 Chapter 15 PA WG keeps their 3YP detail in an Excel Spreadsheet on their HL7.org site. The WG is unclear of the nature or requirements of this item.

• Action: Talk to Dave Hammil about this item. Responsible: Alex. Due: March 2015
  

Project# 1101 Services Directory Rel 2 –This may be a dup of 1121. Action: Ask Brian about the status of this item. Responsible: Alex. Due: March 2015
Alexander mentioned that John Roberts mentioned that he sent an email about PV1-4 to the listserve about a month ago and has not received and answer.

• Action: Find the email from John Roberts to the PAWG listserv and assure that the item regarding PV1-4 is addressed.
  

The WG reviewed the work group health.

The final thing was a statement from Alex about the PSS for the OASIS work. He confirmed with Karen that the MOU was done. We can now update the PSS with the new template (Elyse will do that) then we can send the PSS to the ARB to be sure it is ok.
Agenda for May
GS1 – Mary Kay McDonald
FHIR Management Group Update on telecon – Brian Postlethwaite
Line will put together a draft for the WGM in Paris. The first telecom will be Monday, February 2, 2015.
Alexander H moves to adjourn. Toril seconds.
Vote: 4/0/0
Meeting adjourned at 5:20PM

Meeting Outcomes

Actions (Include Owner, Action Item, and due date)

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